Welcome! Blood, guts, trauma, surgery, and life saving intervention keep us on the adrenaline roller coaster of the ER. Of course, it's not always positive. The ER can be an emotionally taxing and sometimes heartbreaking workplace, and this blog serves as an outlet for the stress of making life and death decisions each and every day.

Wednesday, July 4, 2012

Happy freaking fourth of july....

Oh, fourth of July. A very exciting day for beer and sun, and a not so fun day for pets.

But this isn't a story about fireworks, phobia, lost dogs or hit by cars - the classic fourth of July ER stories.

This is a story about clients with no sense.

Clients arrived to our hospital, reporting that their 8 year old German Shepard dog was having difficulty giving birth. (Yes, you read that right. EIGHT year old LARGE breed dog). The dog has no socialization, has not been trained at all, cannot be restrained, does not use a leash and alligator rolls if we try to handle her, even to listen to her heart or try to look at her mucous membrane color.

Already frustrated, a technician quickly gathers some information from the client.

Tech: Is the female vaccinated?
Client: Well, I do them myself. How often does that usually happen?

Tech: 1-3 years, it depends on your dog and the vaccines.
Client: Oh, yes, definitely I do them in that time. Oh, yes, I definitely gave them.

Tech: What about rabies vaccine?
Client: Oh, yes I definitely gave that one too.

Tech: You realize that you can't legally purchase a rabies vaccine and therefore it can only be given by a veterinarian according to many regulations and laws?
Client:<Stammers> uhhh, I guess she doesn't have that one.

Tech: Was this an intentional breeding?
Client: Yes. She's eight years old and I wanted her to have her first litter.

Tech: Did she have any pre-natal preventative care, deworming, or x-rays to see how many? Do you understand how to whelp puppies?
Client: No.

<SIGH>.

The client reports that the bitch had one puppy at home, about 4 hours prior to arrival, and immediately bit the entire back leg off. They have the puppy in the hospital for an evaluation, but don't want to have to pay for an exam. I look at the puppy anyway, and it's grave. Two legs and a tail are missing; this poor newborn has pretty much no chance at a normal life.

I return my attention to the female. On exam, another puppy is in the birth canal. I assist delivery of this puppy and it resuscitates easily. And that's the very last thing that goes right.

The clients admit they also have no funds to pay for any sort of care for the female or her litter. As in, absolutely zero dollars and zero cents. It quickly becomes apparent that these "owners" were trying to make some quick money by breeding their geriatric dog, and it has gone terribly, terribly wrong.

For better or worse, they were able to come up with $200 total. Imaging confirms 2 more puppies, one in the birth canal, and one behind it. Another exam reveals the next puppy is in the canal, but is not making progress. As time passes, medications given to try and assist labor have no effect. Manipulation to try and move the puppy forward has no effect. The puppy is too large, and the female needs an immediate c-section.

I discussed with the clients the unfortunate situation and recommend the only next steps to get the puppies out - surgery. The clients re-iterate that they cannot agree to proceed with surgery and after arguing with me, take her home against medical advice, with the puppies still stuck and her unable to make progress.

I try my best to helpfully explain the situation, monitoring at home, and some low-cost options for spay the following morning, as the clients are out of options for middle-of-the-night care. As they leave, I ask them if they have any questions. Snarkily, the man replies,

"I'm just worried about my dog. I don't think you get that."

Seriously? It's MY fault that you didn't spay your dog, bred her on purpose too late in life, didn't educate yourself on the birthing process, didn't save or plan for possible complications and now she's in dire straits?

Instead of that reply, I actually said, "I'm sorry, sir, that you're in this tough situation. However, it is completely preventable with spaying to prevent pregnancy, and if you did really want a litter, education and financial planning for emergencies, as well as realizing that allowing an 8 year old large breed dog to have a litter is comparable to a 60-70 year old woman. I am very sorry that you have to leave without surgery this evening, but you have to understand that there's no way we can provide free several thousand dollars of care and still manage to pay our bills and keep our doors open. We wish you the best, and I hope you find a solution in the morning when the low cost clinics open up for the day.

An awful, frustrating situation. As much as I did not approve of the client's attitude and treatment of their pet, I was highly concerned worried for her welfare. I called to check on her the next day. The clients reported that they were forced to surrender her as no clinic could provide low cost options due to her very risky status. She was no doubt turned over to a family that will provide far superior care -any care is superior to level of these lamewads.

I'm glad you told them the truth, instead of glazing over how the bad situation was entirely their fault. I just did that yesterday with clients who let their cat not eat for a month before finally bringing it in on emergency because it collapsed. It was icteric and had petechia and was skin and bones, and they chose euthanasia over the $2000 estimate I gave them. I couldn't get much empathy going, as you can imagine.

Dr. M, I'm sad to say that's not the only time I've heard that. I have had at least two bright yellow cats not eating for >5-6 weeks brought in on emergency for something unrelated to the fact that the cat DIDN'T EAT FOR A MONTH. Really?! I don't feel empathy for the client in that case, I just feel really bad for the pet :(

Do you really think that wherever she was surrendered to will find a home for an unsocialized, untrained, old-ish dog? I'm truly curious. I would expect she would be euthanized rather than be provided expensive care. Poor girl. Totally preventable. I HATE that people irresponsibly breed animals and have no expectation or preparation for taking care of possible complications.

I don't know the answer to that. I suspect that she may have been euthanized for those exact reasons - but most vets I know would just tell the person that, instead of taking them under the auspices of a new home and then euthanizing the dog. I wish I could believe they knew their mistake and wouldn't repeat it, but I don't think they had even that much sense. :(

Honestly if the pups had made it through the birth, things may still not have turned out well. I got my puppy because some back-yard breeder let his dogs get into a fight, this little pup had multiple bite wounds down his back. The dog was dumped on the road somewhere in town. The SPCA was called, picked him up and brought him to the ER I worked at (vet tech) and were going to put him to sleep because of the wounds--there were maggots but we washed him up and he was fine. I refused, and offered to take him.

All stories contained within this blog are inspired by my life as an emergency veterinarian. Details including but not limited to name, time of visit, species, and age are changed to protect the innocent and crazy alike. Any relationship to persons or animals, living or dead, is purely coincidental.

This isn't web DVM....

These stories are shared to inspire and to entertain. They are not intended to be medical advice. If your pet is sick, the only rational thing to do is have him or her seen (in real life) by a veterinarian.

Who is that masked woman, anyway?

Ever since I was little, I always had the dream of becoming a veterinarian. The dream has been realized, and my passion is emergency medicine. ER work has many pitfalls and disadvantages, but for me, the ability to be there in a moment of crisis and help both a beloved pet and their loving family, is worth the bad days.

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Definitions and commonly seen conditions

Anemia: Low PCV (see below). Anemia can result from external hemorrhage, internal hemorrhage, destruction of blood cells in the body, or inability to make new blood cells in the bone marrow.

Azotemia: Elevation in the BUN (blood urea nitrogen) or creatinine. BUN and creatinine are body wastes typically eliminated by the kidneys; increased levels in the body indicate kidney dysfunction, obstruction of urine, or severe dehydration.

Congestive Heart Failure (CHF): Accumulation of fluid in the lungs due to failure of the heart. Some symptoms include shortness of breath, decreased appetite, rapid breathing rates, coughing, and weakness.

Feline Lower Urinary Tract disease (also called feline idiopathic cystitis): A condition resulting in frequent, painful urination, and in the most severe cases, obstruction of the urethra. FLUTD has several potential causes and is also an extreme emergency.

GDV: Gastric dilatation and volvulus. Occurs in large breed dogs; the stomach fills with gas and twists. An extreme emergency, this condition is treated with stabilization and immediate surgery.

PCV: Packed cell volume. The percentage of red blood cells contained within a given sample of whole blood. Normal for dogs and cats is typically 35%-45%.